Title

Improved patient-perceived resident competency in Family Medicine minor procedures with use of an iPAD application "app" training tool

Theme

3AA Mobile learning and social networks

Authors

Ian MacPhee Jeremy Rezmovitz

Institutions

University of Toronto - Canada

Background

Competency in Family Medicine procedures requires both manual and cognitive skills. The cognitive component includes knowledge of when to do a procedure and the skill to communicate the risks, benefits, and side effects to the patient. Manual skill includes motor control and technique.

Over the past 3 years, we developed an iPAD app (Proceducate) to assist in the teaching of common Family Medicine procedures. The need for the app grew from an observation that there were a number of limitations in training residents in the core Family Medicine procedures. Some of these barriers to training include the small number of patients requiring certain procedures, the lack of clinical exposure for residents, and the haphazard manner in which it is learned.

The concept of utilizing patients to provide insight into the level of competency of a medical trainee is not new. Patients have been used to assess competency in the areas of cultural sensitivity as well as surgical care. While there are a number of factors influencing a patient’s perceptions of care, one cannot deny that patients provide an opportunity to get input from a source who has the most to lose or gain from someone’s competency.

Direct observation of the patient-resident interaction by the supervising physician is one method of evaluating resident competency. In our study, supervising physicians still did direct observation of the resident-patient interaction but since patients were blinded to the allocation, we used patients to assess perceived resident competency after using an iPAD app training tool for Family Medicine minor procedures.

Summary of Results

Overall Satisfaction

Values are displayed as means (SD)

TOTAL SAMPLE (N = 100)

Control (n = 41)

Intervention (n = 59)

p-value

Result

6.2195122 (1.6203733)

6.7333333 (0.5783280)

0.0261

Statistically significant if alpha level = 0.05

DR. REZMOVITZ (n = 56)

Control (n = 24)

Intervention (n = 32)

p-value

Result

6.2083333 (1.6934443)

6.7500000 (0.5080005)

0.0923

Not quite statistically significant

DR. MACPHEE (n = 44)

Control (n = 17)

Intervention (n = 27)

p-value

Result

6.2352941 (1.5624265)

6.7037037 (0.6688000)

0.1758

Not statistically significant

PROCEDURE TYPE - Cryotherapy (n = 13)

Control (n = 3)

Intervention (n = 10)

p-value

Result

7.0000000 (0)

6.9000000 (0.3162278)

0.6059

Not statistically significant

PROCEDURE TYPE – Excisional biopsy (n = 13)

Control (n = 6)

Intervention (n = 7)

p-value

Result

6.5000000 (0.5477226)

6.8571429 (0.3779645)

0.1930

Not statistically significant

PROCEDURE TYPE – Ganglion cyst removal (n = 11)

Control (n = 4)

Intervention (n = 7)

p-value

Result

6.2500 (0.9575)

6.7143 (0.7559)

0.3946

Not statistically significant

PROCEDURE TYPE – Joint injection (n = 23)

Control (n = 9)

Intervention (n = 14)

p-value

Result

5.4444444 (2.5549516)

6.5714286 (0.8516306)

0.1386

Not statistically significant

PROCEDURE TYPE – Punch biopsy (n = 22)

Control (n = 11)

Intervention (n = 11)

p-value

Result

6.2727273 (1.7939292)

6.7272727 (0.4670994)

0.4257

Not statistically significant

Table 1. Results of patient-perceived resident competence for pooled results of all performed procedures with both physician instructor groups.

Summary of Work

Over a 12 month study period, the Family Medicine Procedures Clinic at Sunnybrook Health Sciences Centre was able to recruit 100 patients to participate in evaluating resident learners on perceived competency. The control group was comprised of 41 evaluations and the intervention group had 59 evaluations. Analysis of the collected data showed a statistically significant increase in patient-perceived resident competency compared to the control group (p<0.05). The results also show that the choice of physician instructor involved in the clinic had no impact on the outcome. Furthermore, comparing the control to intervention, group variables including the perceived level of skill of the resident, the type of procedure or which physician instructor showed no statistically significant difference between the groups.

As the patients were unaware of the type of training we were evaluating and which group the resident was assigned to, the results suggest that our iPAD app is able to assist our residents in achieving competence.

Looking at the data closer showed no differences between groups in perceived skill level of the resident or the types of procedures performed by the residents. In addition, which physician instructor was involved in the teaching of the clinic had no statistically significant influence on the results.

Conclusion

Access to the iPAD app mobile eLearning platform (Proceducate) is a simple way to improve resident competency in family medicine procedures and is becoming an integral part of our Family Medicine resident training. Future studies will explore the role of the app in resident education. Proceducate is being prepared for release via the iTunes Store and a version for the Android operating system is being developed.

Take-home Messages

1. Technology can be an effective tool to improve the learning of our resident learners.

2. Patients can provide insight into the level of competence of family medicine residents.

Acknowledgement

The authors wish to acknowledge the contributions of Derek Fullerton (Animation), Kei Turner (Programming), and John Mills (Voice) in the creation of Proceducate, and Bonnie Au for statistical analysis of the collected data. We also wish to thank the PGY-1 and PGY-2 residents for agreeing to take part in this study and to the many patients who took the time to complete our questionaires.